alcohol misuse in derbyshire 2009 reducing alcohol-related harm and health inequalities from alcohol...

Alcohol misuse in Derbyshire 2009

Reducing alcohol-related harm and health inequalities from alcohol misuse

Reducing alcohol-related harm and health inequalities from alcohol misuse are the

responsibilities of;

• The local Derbyshire Drug and Alcohol Action Team (DAAT) partnership

• The Derbyshire Partnership Forum’s Local Area Agreement

Developments in the last year

A new Drug and Alcohol Strategy 2009-13 was launched in 2009 with theaim of achieving the following outcomes;

• Fewer hospital admissions related to alcohol, particularly in the under 18 year olds in North Derbyshire

• Lower treatment wait times

• Fewer people developing alcohol-related problems

• Less alcohol-related crime and anti-social behaviour.

Developments in the last year

• DAAS opened a new countywide adult service for tier 2 open access treatment in April 2009

• Training on identification and brief advice provided for tier 1 staff

• DAAT opened tender process for tier 3 adult treatment services for implementation from 1 January 2010

• (Set up a?) Young people’s specialist substance misuse treatment service (tier 3)

• Additional targeted alcohol and drug workers (tier 2) embedded in each Children and Younger Adult (CAYA) district

• Universal provision of tier 1 interventions within partner organisations

• DAAT commissioned prevention, education and community safety initiatives E.g. the marketing campaign, the Strengthening Families Project (SFP) and the BeSafe pilots.

Information to support commissioning

In the last year two key analyses have been undertaken:

1) A children and young people’s health needs assessment – to investigate the reasons for the high under 18s alcohol-specific admission rates in Derbyshire County

2) Local analysis of Hospital Episode Statistics (HES) – to explore patterns of alcohol-related admissions in Derbyshire by age, gender, local authority and reason for admission.

NB. Findings from these analyses, along with the implications for

commissioning, are detailed in the following sections of this presentation.

Alcohol and admissions to hospital - Definitions

• Alcohol-specific admissions only include conditions caused wholly by alcohol (e.g. alcoholic liver disease or alcohol overdose);

• Alcohol-related admissions include all the alcohol-specific conditions, plus those that are caused by alcohol in some, but not all, cases (e.g. breast cancer and road traffic accidents).

Young people and alcohol -Derbyshire health needs assessment

Young people and alcohol

Alcohol consumption patterns developed during adolescence can influence consumption in later life.

It is therefore important to understand the frequency and level of alcohol consumed locally in order to understand;

• how drinking patterns may develop • what interventions may be needed to achieve the best possible

health outcomes• To help us to plan for future treatment demand.

Alcohol-specific admissions for under 18s in Derbyshire 2002/3–07/8

• There are approx 168,000 young people in Derbyshire under 18 years of age

(approx 20% of the population)

• Over three years from 2005/6 to 2007/8 there were 377 hospital admissions

specifically related to alcohol (or 74.7 per 100,000 young people per year).

Young people and alcohol

Figure 1 Under 18 Alcohol-specific Admissions

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Bolsover Chesterf ield DerbyshireDales

Erew ash High Peak North EastDerbyshire

SouthDerbyshire

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Source: HES data, Department of Health, analysed by Derbyshire County PCT

Under 18 alcohol-specific admissions by local authority in Derbyshire 2007-08 with 95% confidence intervals

• The alcohol-specific hospital admission rate in Derbyshire was lower than the England average, but some local authority areas in Derbyshire were significantly higher than England

• High Peak, Chesterfield, Bolsover and North East Derbyshire are respectively ranked 2nd, 3rd, 4th and 5th highest of the 40 local authorities in the East Midlands

Figure 2


Under 18 alcohol-specific admissions in Derbyshire by MSOA

Aggregated number of under 18 alcohol-specific admissions in Derbyshire 2002-2008

• Nearly twice the number of girls than boys aged 14 and 15 are admitted into hospital relating to alcohol

• Some young children (under the age of 6) are also admitted into hospital, mostly because of methanol poisoning (NB. numbers are too small to present)

• For adolescent girls the peak in admissions is at age 15

• For boys the peak in admissions is into early adulthood (data not shown).

Aggregated number of under 18 alcohol-specific admissions in Derbyshire 2002-2008 Total (summed) admissions (small numbers <5 excluded)

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Figure 3


Every Child Matters survey Derbyshire 2007 (School Health Education Unit, SHEU)

829 Year 8 and 10 pupils were asked a range of questions within the five outcome categories

of Every Child Matters;• 41% of students said that they drank alcohol on at least one day in the week• 6% said they bought it from an off-licence.

TellUs3 survey Derbyshire 2008• 11% of young people (pupils from years 6, 8 and 10) said that they had been drunk three

or more times in the past four weeks. This is nearly twice the national figure of 6%. • 67% of pupils thought the information they received regarding alcohol was good enough • 25% thought they needed better information and advice.

Qualitative analysis

The Derbyshire health needs assessment included focus group work with young people and

with service providers to gather their views and experiences.

Research findings – Alcohol and young people

Main recommendations for commissioning children and young people’s

alcohol services

Commissioning children and young people’s alcohol services – recommendations

The JNSA made fifteen recommendations which include the following:

Develop a cross-agency agreement and key desired outcomes for alcohol harm

reduction in young people; - To be led by the DAAT Children’s Joint Commissioning Group (JCG) and overseen by

the Children and Younger Adults Trust- Agencies to include; the police, community safety, trading standards, CAYA (youth

service/ connexions), targeted youth support, safeguarding children and DAAT.

Develop a streamlined, integrated commissioning of services plan to meet the

agreed outcomes;- To include universal, targeted and treatment services- The DAAT Children’s JCG to lead on the development of this with clear governance

arrangements in place for accountability and reporting to the Children and Younger Adults Trust.

The DAAT Children’s JCG should review the current commissioning

arrangements for the targeted alcohol and drugs service in order to

ensure:

• fail safes for referral management;

• the delivery of evidence-based interventions;

• consistent service management and performance reporting across districts and providers (Youth Service, Connexions, Looked After Children and Youth Offending Services);

• its capacity is responsive to potential future changes in demand.

This should be developed and monitored by the DAAT Children’s JCG with

Exception reporting to the Children and Younger Adults Trust.

Commissioning children and young people’s alcohol services – recommendations cont.

Alcohol-related admissions in all ages

Alcohol-related admissions in all ages

As part of the Derbyshire Local Area Agreement, Derbyshire County

PCT and Derbyshire County Council are monitored on alcohol-related

admission rates (LAA indicator NI39).

This indicator measures the rate of alcohol-related hospital admissions

per 100,000 population.

• Provisional data for 2008/09 show the actual rate of admissions in

Derbyshire was 1688 per 100,000 (16,004 admissions) compared to the target rate of 1600. This is an increase of 12% from 2007/08.

Figure 4

NI39 Alcohol-related admission rates for Derbyshire - comparison of actual and projected with target

(Projections for 2009-10 and 2010-11 based on linear trend;2008-09 data is provisional)

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Target 1600 1680 1753

Actual 1045 1133 1305 1341 1364 1504 1688

Projected 1730 1828

2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11

Source: Department of Health, analysed by Derbyshire DAAT

Alcohol-related admission rates and LAA targets in Derbyshire

Local analysis of HES data for alcohol-related admissions

(2002/03‑07/08)

A detailed analysis of HES data – by age, gender, diagnosis on

admission and local authority of residence has been undertaken in

order to understand alcohol-related health inequalities in Derbyshire

And to inform future commissioning decisions.

Alcohol-related admissions in all ages cont.

Alcohol-related admission rates by age group in Derbyshire 2007-08

• Males have a significantly higher rate of alcohol-related admissions (1866 per 100,000) compared with females (1142)

• Both male and female admission rates increases with age, but the gap between males and females widens from 45 years onwards

• Over 85s have the highest rates due to the increasing number of admissions for alcohol-related chronic diseases.

• The rise in admission rates with age (particularly from age 45 onwards) emphasises a need to focus on binge drinking and longer-term drinking that builds

morbidity over time.

Alcohol-related admissions by age group 2007-08

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Figure 5


Alcohol-related admission rates

by local authority 2002/03‑07/08 • In 2007/08 Chesterfield had

the highest local authority rate of alcohol-related admissions (1902 per 100,000), significantly higher than the Derbyshire average.

• Bolsover was also significantly higher than the county average at 1744 per 100,000.

• All districts within Derbyshire have seen increases in alcohol admissions over the past six years, with South Derbyshire showing the biggest increase.

Alcohol-related admissions by local authority, 2002/03 - 2007/08

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Figure 6


Alcohol-related admissions 2007/08 in Derbyshire

Source: HES data, Department of Health, analysed by Derbyshire County PCT.

Top 6 diagnostic groups for alcohol-

related admissions 2002/03 – 2007/08 Figure 8

Top 6 Diagnostic Groups for Alcohol-related Admissions: 2002/03 - 2007/08

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Hypertensive DiseasesCardiac arrhythmiasMental & behavioural disorders due to use of alcoholEpilepsy and Status EpilepticusAlcoholic liver diseaseEthanol

The three biggest sources of alcohol-related hospital admissions for Derbyshire are;

• hypertensive disease (37% of admissions)

• cardiac arrhythmias (18%)

• mental and behavioural disorders due to the use of alcohol (12%)


Recommendations for reducing alcohol-related admissions

Recommendations

Reduction of alcohol-related admissions can only be effective if actions

encompass the broader aspects of reducing alcohol-related harm comprising;

treatment, community safety and prevention and education:

• Action to minimise harm caused by alcohol should be included and embedded in strategies at a local level (e.g. Local Strategic Partnerships, children’s partnerships), include a focus on geographic/socio-economic areas of high admissions and link to other lifestyle work on smoking, obesity, sexual health, physical activity, mental health promotion, heart disease and services for older people

• Develop education and communication around sensible drinking, the impact of alcohol and local alcohol service information, utilising innovative communications best practice (e.g. social marketing approaches; utilising “peer educator” approaches)

• Develop effective ways to highlight the dangers of binge drinking, particularly in young people and their families and work with parents/ guardians and young people to help clarify the potential dangers of alcohol to young people.

• Partners should ensure front-line staff receive training on simple assessment, brief interventions and the provision of advice and information. (Frontline staff should include police officers, housing, probation, voluntary sector workers and health trainers)

• Work with partners to consider measures to reduce alcohol-related crime such as;- supporting the VALs (Violence, Alcohol harm, Licensing groups)- providing leisure facilities for those in recovery - diversionary activities for young people (e.g. Positive Activities agenda)- promoting good alcohol workplace policies, including disseminating safer drinking

messages to staff)

• Screening and brief interventions should be offered to hazardous and harmful drinkers who attend primary care and other NHS settings such as A&E departments, sexual health clinics or fracture clinics

• Ensure alcohol liaison workers are in place in hospital wards and A&E

• GPs and other primary care staff should be given appropriate training and support to provide screening and brief interventions.

Recommendations cont.

• Screening and brief interventions offered in non-NHS settings such as social services, criminal justice settings, prisons, housing, education and voluntary sector organisations

• Undertake review of current treatment system to ensure that the needs of AACCE users (alcohol, amphetamine, cannabis, cocaine, ecstasy), particularly those aged 18-25, are being adequately met

• Undertake needs assessment to identify requirement for access to housing and housing support for those with alcohol problems and on the path to recovery, including those leaving prison

• Utilise “good practice” resources nationally and across our East Midlands region e.g. http://www.alcohollearningcentre.org.uk; http://www.hubcapp.org.uk

Contributors: Alison Pritchard, Diane Steiner, Liz Orton,

Nicki Richmond, Mary Hague

Recommendations cont.

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